Colon Mass, Pediatric

A "mass" is a lump that either your caregiver found during an examination or you found on your child before seeing your child's caregiver. The "colon" is a major part of the large intestine. There are many possible reasons why a lump has appeared. Testing will help determine the cause and the steps to a solution.

CAUSES

Before complete testing is done, it may be difficult or impossible for your caregiver to know if the lump is truly in the colon or is from one of many organs that are next to the colon. Problems in the liver, gallbladder, pancreas, kidney, small intestine, uterus, and ovaries can also lead to a lump that might seem to be in the colon.

If testing shows that the mass is in the colon, there are still many possible causes:

Tumors and cancers. A cancer in an infant, toddler, or child is very uncommon. However any mass that seems to be in the colon must be considered a cancer until proven to be something non-cancerous. These problems are the greatest source of worry for parents with children undergoing these evaluations. Cancerous lumps in the colon may be due to cancers that start in the colon or due to cancers that started in other areas and then spread to the colon. Many childhood cancers are very treatable when found early.

Non-cancerous tumors and masses. There are a large number of common and uncommon non-cancerous problems that can lead to a mass in the colon. For example, there may be displaced tissue left over from fetal development that gets enlarged and scarred and is detected as a mass. In other cases, an overgrowth of normal tissue can take place leading to the enlargement of an organ and development of a mass. Before testing and/or surgery, it may be impossible to tell the difference between these types of problems and a cancer.

Infection. Certain types of infections can produce a mass in the colon. The infection might be caused by a bacteria. The treatment might include medicine that kills bacteria (antibiotics). Masses from infection can also be caused by certain viruses, fungi, and parasites. If infection is the cause, your caregiver will be able to determine the type of germ responsible for the mass by doing appropriate testing. In more severe cases, hospitalization will be necessary.

Inflammatory bowel disease. These are diseases thought to be caused by a defect in the immune system of the intestine. Two inflammatory bowel diseases are: Ulcerative Colitis and Crohn's Disease. They are lifelong problems with symptoms that can come and go. Not all patients with these diseases will develop a mass in the colon. Effective treatments are available.

Blood vessel problems. A partial block of the blood supply to the intestine can lead to swelling of the wall of the colon. If this happens, a mass can develop. Although only affecting about 2 out of every 1000 children, a common form of this problem is called intussusception. This is a condition where one portion of the colon slides into the next much like the pieces of a telescope. This leads to a blockage in the colon, a cut off of blood supply, and development of a mass. Although the symptoms may come and go, the pain is always severe when the blood supply is blocked.

Past Surgery. If there has been colon surgery in the past, and there is a lot of scarring that forms during the process of healing, this can eventually feel like a mass when examined by your caregiver. As with the other problems described above, this may or may not be associated with symptoms or feeling badly.

Volvulus. This is a condition where the colon twists on the organ/tissue that supports the colon (mesentery). In children, two-thirds of cases occur in newborns, and in most cases, the mid-section of the colon is the part that twists. The problem causes blockage of the colon. In severe cases, part of the colon can die. Along with a mass, there are almost always problems of inability to feed and vomiting of fluid that contains bile. In older children, there is pain, and there may be blood in vomitus and in diarrhea along with a mass on examination.

In children with a colon mass, there may be a large variety of associated symptoms including:

No symptoms, other than the appearance of the mass itself.

Pain, nausea, diarrhea.

Fever, vomiting, weakness.

Abdominal, side, and/or back pain.

Poor appetite.

Weight loss.

Constipation.

Bleeding from the rectum.

DIAGNOSIS

Because of the large number of causes of a mass in the colon, your child's caregiver will suggest testing in order to get a clear diagnosis in a timely manner. The tests might include some or all of the following:

Blood tests. A blood test may include a blood count; a measurement of common minerals in the blood, kidney/liver/pancreas function, and others.

X-rays. Plain X-rays and special X-rays may be requested.

Ultrasound. An ultrasound is a test that uses sound waves. The sound waves bounce off the organs like an echo. The echoes are "heard" by a device called a transducer. The transducer converts the sounds into an electronic picture of the organ or structure. Your caregiver will examine this picture.

CAT scan and MRI imaging. Each can provide additional information as to the different characteristics of the mass and can help to develop a final plan for diagnostics and treatment. If cancer is suspected, these special tests can also help to show any spread of the cancer to other parts of the body.

Colonoscopy. This is a special exam of the inside of the colon with a slim, flexible, lighted tube. This tool allows your caregiver to get a direct look at the mass from the inside of the colon. Sometimes, this allows getting a very small piece of the mass (biopsy). This piece of tissue can then be examined in a lab. Looking at the tissue in this way will frequently lead to a clear diagnosis.

Surgery. Sometimes, a diagnosis can only be made by carrying out an operation and obtaining a biopsy (as noted above). Many times, the biopsy is obtained and the mass is removed during the same operation.

These are the most common ways for determining the exact cause of the mass. Your caregiver may recommend other tests that are not listed here.

TREATMENT

Treatment(s) can only be recommended after a diagnosis is made. Your caregiver will discuss your child's test results with you, the meanings of the tests, and the recommended steps to begin treatment. He or she will also recommend whether your child needs to be examined by specialists as you go through the steps of diagnosis, and a treatment plan is developed. In serious cases, emergency surgery may be recommended immediately.

HOME CARE INSTRUCTIONS

Test preparation. Carefully follow instructions when preparing for certain tests. This may involve medicines that clean out the intestines before colonoscopy, fasting before certain blood tests, or drinking special "contrast" fluids that are necessary for CAT scan and MRI images.

Medicine. Your caregiver may prescribe medicine to help relieve symptoms while tests are being done. It is important that you tell your caregiver about any current medicines (prescription, non-prescription, herbal, vitamins, etc.) your child is taking.

Diet. There may be a need for changes in formula or diet to help with symptom relief while testing is being done. If this applies, your caregiver will discuss these changes with you.

SEEK MEDICAL CARE IF:

Recommended fluids used to prepare for tests (such as colonoscopy, CAT scan, or MRI) cannot be held down.

There are problems with any new prescriptions.

New symptoms of pain, vomiting, diarrhea, fever, or other problems develop that were not present at the last exam.